Healthcare Provider Details

I. General information

NPI: 1982965158
Provider Name (Legal Business Name): ERIN BENNETT RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE
WASHINGTON DC
20003-3722
US

IV. Provider business mailing address

1220 12TH ST SE
WASHINGTON DC
20003-3722
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-7949
  • Fax:
Mailing address:
  • Phone: 202-715-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1012942
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: